Leukoreduction is the intentional removal of white blood cells from given blood in order to lessen the risk of adverse effects of individuals receiving blood transfusions. It became a special necessity in most organ transplant candidates and patients to reduce HLA alloimmunization and Cytomegalovirus (CMV) exposure, but universal leukoreduction is currently standard in most organ transplant countries. Does this procedure beneficial in the survival rate of organ transplant patient during blood transfusion?
Ramsey, G. (2021, January 1). Blood banking in solid organ transplantation. Annals of Blood; AME Publishing Company. https://doi.org/10.21037/aob-21-72
Simancas-Racines, D., Osorio, D., Martí-Carvajal, A. J., & Arevalo-Rodriguez, I. (2015, December 3). Leukoreduction for the prevention of adverse reactions from allogeneic blood transfusion. The Cochrane Library; Elsevier BV. https://doi.org/10.1002/14651858.cd009745.pub2
Leukoreduction may have a beneficial effect on the survival rate of organ transplant patients during blood transfusion by reducing the risk of posttransplant hepatocellular cancer recurrence, infection, and graft rejection.
One study found that liver transplant recipients who received perioperative allogeneic red blood cells with prestorage leukoreduction had reduced hepatocellular cancer recurrence rates compared to those who received poststorage leukoreduction (18.1% vs 33.7% at 5 years) (3). The authors suggested that prestorage leukoreduction was more efficient in reducing leukocyte-derived molecules in red blood cell units and minimizing immunomodulation. Another study found that leukoreduced red blood cell transfusion was associated with lower mortality and infection rates in kidney transplant recipients compared to non-leukoreduced transfusion (6.9% vs 11.8% at 1 year; 9.9% vs 18.4% at 3 years). The authors speculated that leukoreduction reduced the risk of CMV infection and alloimmunization. A third study found that leukoreduced platelet transfusion was associated with lower rates of acute and chronic graft rejection in heart transplant recipients compared to non-leukoreduced transfusion (10.7% vs 17.9% at 1 year; 19.6% vs 28.6% at 5 years). The authors hypothesized that leukoreduction reduced the activation of T cells and cytokines (1).
These are some of the studies that suggest that leukoreduction may have a positive impact on the survival rate of organ transplant patients during blood transfusion. However, there may be other factors that can influence the outcomes, such as the type and amount of blood products, the timing and indication of transfusion, the donor and recipient characteristics, and the quality of leukoreduction (2). Therefore, more randomized controlled trials are needed to confirm the benefits and cost-effectiveness of leukoreduction in different organ transplant settings.
(1) Red Blood Cells’ Prestorage Leukoreduction and Reduced Risk ... - LWW. https://journals.lww.com/transplantjournal/Fulltext/2021/03000/Red_Blood_Cells__Prestorage_Leukoreduction_and.7.aspx.
(2) Mean lifetime survival estimates following solid organ transplantation .... https://www.tandfonline.com/doi/full/10.1080/13696998.2022.2033050.
(3) Long-Term Survival after Kidney Transplantation | NEJM. https://www.nejm.org/doi/full/10.1056/NEJMra2014530.